The edition · Geriatrics
Not every fall-risk drug is equal: SSRIs, older antiepileptics and anticholinergics marked the older adults most likely to be admitted after a fall
A German cohort of 120,867 older adults on fall-risk drugs shows which classes to review first, a BMJ network meta-analysis puts a dose on exercise for bone, and anticholinergic burden tracks with falls and cognitive impairment in frail people with orthostatic hypotension.
The edition in brief
Today's geriatrics edition closes on an Age and Ageing cohort (4 September) of 120,867 adults aged 65 and over prescribed at least one fall-risk-increasing drug; 2.3% were admitted after a fall within a year. Serotonin reuptake inhibitors, older antiepileptics and drugs with moderate anticholinergic activity marked higher risk, and a broader adverse-reaction framework added little. The model discriminated moderately (AUC 0.73). The practical point is to start medication reviews with those classes rather than every drug on the list. The lead is a BMJ hierarchical network meta-analysis (9 September) of 124 trials and 18,429 adults aged 40 and over: brisk walking or jogging and combined aerobic-resistance training improved spine and hip bone density, with meaningful effects around 600 MET-minutes a week — about two to three hours of brisk walking — and mixed aerobic and mind-body exercise may reduce fractures, all on low-to-moderate certainty evidence. A Turkish cross-sectional study of 1465 older adults (JAMDA, 1 August) found that among frail people with orthostatic hypotension, any anticholinergic burden was associated with falls (OR 2.39) and cognitive impairment (OR 3.63). A TriNetX cohort (Age and Ageing, 4 September) linked GLP-1 agonists in older adults with fatty liver to less decompensation but not fewer cardiovascular events. The pearl is on measuring lying and standing blood pressure before a medication review.
Exercise for bone: about two to three hours of brisk walking a week reached a meaningful effect
Prescribe exercise for bone health as a dose — around two to three hours of brisk walking a week, plus resistance or tai chi where possible.
Frail with orthostatic hypotension: any anticholinergic burden was associated with falls and cognitive impairment
In frail patients with orthostatic hypotension, review and reduce anticholinergic drugs first.
GLP-1 agonists in older adults with fatty liver: associated with less decompensation, but no fewer cardiovascular events
In older adults with fatty liver starting a GLP-1 agonist, protect muscle and bone as weight falls; the liver benefit is promising but observational.
Measure lying and standing blood pressure before the medication review
Do a lying and standing blood pressure before every medication review in an older patient who falls or is frail.
Start fall-prevention medication reviews with SSRIs, older antiepileptics and anticholinergics
When reviewing medicines for fall prevention, start with SSRIs, older antiepileptics and anticholinergic drugs.
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